Provider Demographics
NPI:1104194539
Name:NIEVES, YADERIS ROSA (CERTIFICADE)
Entity Type:Individual
Prefix:MRS
First Name:YADERIS
Middle Name:ROSA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:CERTIFICADE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 36011
Mailing Address - Street 2:BO. ACEITUNAS SECTOR OJO CARR 464 KM 3.3 INT
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9028
Mailing Address - Country:US
Mailing Address - Phone:787-235-9484
Mailing Address - Fax:
Practice Address - Street 1:BO. ACEITUNAS SECTOR OJO CARR464 KM3.3
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-896-1850
Practice Address - Fax:787-896-8025
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8698183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician